Available data suggest low rates of adherence to guideline based treatment of acute myocardial infarction (AMI) in many hospitals, particularly in rural settings. Hospitals with low rates of adherence to guideline-recommended therapies have worse clinical outcomes than those with high rates of adherence. The effectiveness of many quality improvement programs focusing on guideline-based care has not been studied in rural settings nor have rural hospitals been specifically targeted. We propose the use of a medical simulator as an avenue for a novel educational program for AMI care in rural settings. The objectives of this project are to assess the current state of AMI care and to evaluate whether a novel educational intervention using simulation-based training, focusing on recognition and management of AMI patients presenting to rural hospitals, can improve AMI performance measures and adherence to guideline recommended care for high-risk cardiac patients. The specific aims are: 1) to assess the current state of AMI care in rural hospitals in Colorado; 2) to implement a simulation-based training program designed for physicians and nurses in family medicine, internal medicine and emergency medicine focusing on the recognition and guideline-based management in rural hospitals in Colorado; and 3) to re-assess AMI care at the intervention hospitals following the educational program. Chart abstraction of AMI cases at multiple rural hospitals in Colorado will be performed to assess the quality of AMI care using specific performance measures published by the ACC/AHA Task Force on Performance Measures for the year before and the year after simulation-based training. Both physicians and nurses managing AMI patients in up to 10 rural hospitals will complete a several hour didactic curriculum focusing on recognition and guideline based management of AMI, using simulated clinical scenarios with a commercially available mobile simulator (SimSuite Training System). AMI care before and after simulation-based training will be compared and also benchmarked to other rural centers. With this project, we hope to assess the current quality of AMI care in rural hospitals in Colorado, and assess a new training program using simulation aimed at healthcare providers caring for AMI patients in rural settings. We hope to demonstrate that using simulation training for AMI care and exposure to best practices of care in a novel format will be effective in improving the care of AMI patients in the rural setting. [unreadable] [unreadable] [unreadable]